• Dominique Gossot


Totally endoscopic lobectomies or segmentectomies require the incorporation of different surgical skills and new technologies. Because of the endoscopic vision, with its magnification and unusual viewpoints, anatomical landmarks can be modified. In addition, restricted tissue manipulation and use of endoscopic instruments are disturbing.

Supplementary material

Video 1.1

Examples of scope holders used in our department. a Mechanical (Olympus LTF). b Motorized scope positioner (Viky® EP, EndoControl) (MOV 11610 kb)

Video 1.2

Issue related to endoscope soiling (MOV 62952 kb)

Video 1.3

Demonstration of the interest of intrathoracic cleaning of the endoscope (EndoClear™, Virtual Ports) (MOV 45629 kb)

Video 1.4

The interest of a blood-deflecting trocar (Delacroix-Chevalier) (MOV 41209 kb)

Video 1.5

Needle biopsy of a small nodule for a frozen section (MOV 2933 kb)

Video 1.6

Dedicated thoracoscopic instruments allow a sharp dissection to be performed (MOV 28874 kb)

Video 1.7

Example of exposure achieved by use of throw-off lung forceps (MOV 7544 kb)

Video 1.8

Opening of a tiny and almost complete fissure on the left side, using a vessel-sealing device (MP4 18536 kb)

Video 1.9

Opening of a thick and long fissure on the left side. The fissure is shortened by stapling, thus allowing exposure of the posterior mediastinum. A second application of staples can then be done (MOV 56355 kb)

Video 1.10

Example of a dangerous conflict between a stapler and a clip (MOV 336864 kb)

Video 1.11

Combined use of clips and a vessel-sealing device to control medium-sized vessels (MOV 13073 kb)

Video 1.12

Demonstration of the interest of an articulated sealing device for severing pleural adhesions (MOV 4470 kb)

Video 1.13

Serious hemorrhage from a tear in a left A6 artery, with temporary control by packing (MP4 4427 kb)

Video 1.14

Example of vascular control using a throw-off bulldog clamp (MP4 9949 kb)

Video 1.15

Clamping of the intersegmental plane with help from ventilation during a right S1+2 segmentectomy (MOV 552551 kb)

Video 1.16

Selective insufflation of S1 and S2 segments by a direct puncture during a left S1+2 segmentectomy (MOV 50715 kb)

Video 1.17

Dissection of the bronchial stump during a right S1+2 segmentectomy to keep it remote from the vessels and the parenchyma (MOV 62496 kb)

Video 1.18

Repair of a minor parenchymal tear from a trocar puncture. The stitch is secured by an absorbable clip (Lapra-Ty®, Ethicon) (MOV 15893 kb)

Video 1.19

Example of insufficient room for stapling during a right anterior segmentectomy (S3), requiring manual suturing of the segmental bronchus (MOV 128312 kb)

Video 1.20

Example of manual suturing during a sleeve middle lobectomy for an intrabronchial carcinoid tumor (running suture with intracorporeal knotting) (MOV 150719 kb)

Video 1.21

Example of manual cutting of the bronchial stump and manual suturing during a left upper lobectomy for an intrabronchial carcinoid tumor (interrupted stitches with extracorporeal knotting) (MOV 379595 kb)

Video 1.22

Use of a specimen retrieval bag (MOV 65495 kb)

Suggested Reading

Thoracoscopic Instruments

  1. Büchel D, Mårvik R, Hallabrin B, Matern U (2010) Ergonomics of disposable handles for minimally invasive surgery. Surg Endosc 24:992–1001CrossRefPubMedGoogle Scholar
  2. Gossot D, Merlusca G, Tudor A, Boudaya M, Radu C, Magdeleinat P (2009) Pitfalls related to the use of endostaplers during video-assisted thoracic surgery. Surg Endosc 23:189–192CrossRefPubMedGoogle Scholar
  3. Ikeda Y, Tamura M, Umezu H, Karube Y, Seki N, Kobayashi S, Nagai S, Miyoshi S (2003) Usefulness of mini loop retractor in video-assisted thoracic surgery. Kyobu Geka 56:199–202PubMedGoogle Scholar
  4. Ismail N, Elsaegh M, Dunning J (2015) Novel techniques in video-assisted thoracic surgery (VATS) lobectomy. Surg Technol Int 26:206–209PubMedGoogle Scholar
  5. Sato Y, Tezuka Y, Kanai Y, Otani S, Yamamoto S, Tetsuka K, Sohara Y (2008) Novel retractor for lymph node dissection by video-assisted thoracic surgery. Ann Thorac Surg 86:1036–1037CrossRefPubMedGoogle Scholar
  6. Tanaka R, Nakazato Y, Goya T (2011) The development of new instruments (NT forceps) for video-assisted thoracoscopic surgery. Surg Today 41:303–305CrossRefPubMedGoogle Scholar
  7. Welcker K, Kesieme E, Intermullo E, Kranenburg L (2012) Ergonomics in thoracoscopic surgery: results of a survey among thoracic surgeons. Interact Cardiovasc Thorac Surg 15:197–200CrossRefPubMedPubMedCentralGoogle Scholar

Thoracoscopic Haemostatic Devices

  1. Molnar T, Benko I, Szanto Z, Laszlo T, Horvath O (2006) Lung biopsy using harmonic scalpel: a randomised single institute study. Eur J Cardiothorac Surg 28:604–606CrossRefGoogle Scholar
  2. Otsuka H, Hata Y, Iyoda A (2014) Ultrasonically activated coagulating shears and the vessel sealing system in thoracic surgery. Kyobu Geka 67:727–731PubMedGoogle Scholar
  3. Sakuragi T, Okazaki Y, Mitsuoka M, Yamasaki F, Masuda M, Mori D, Satoh T, Itoh T (2008) The utility of a reusable bipolar sealing instrument, BiClamp, for pulmonary resection. Eur J Cardiothorac Surg 34:505–509CrossRefPubMedGoogle Scholar
  4. Santini M, Vicidomini G, Baldi A, Gallo G, Laperuta P, Busiello L, Di Marino M, Pastore V (2006) Use of an electrothermal bipolar tissue sealing system in lung surgery. Eur J Cardiothorac Surg 29:226–230CrossRefPubMedGoogle Scholar
  5. Tanaka K, Hagiwara M, Kondo Y, Okada K, Masuko H, Hata T, Miki T, Kawamura H, Yamagami H, Honma S, Kato H (2006) Usefulness of ultasonically activated scalpel for pulmonary resection in video-assisted thoracoscopic surgery. Kyobu Geka 59:1171–1175PubMedGoogle Scholar
  6. Toishi M, Yoshida K, Agatsuma H, Sakaizawa T, Eguchi T, Saito G et al (2014) Usefulness of vessel-sealing devices for ≤7 mm diameter vessels: a randomized controlled trial for human thoracoscopic lobectomy in primary lung cancer. Interact Cardiovasc Thorac Surg 19:448–455CrossRefPubMedGoogle Scholar

Cost Analysis

  1. Burfeind W, Jaika N, Villamizarb N, Tolozab E, Harpole D, D’Amico T (2010) A cost-minimisation analysis of lobectomy: thoracoscopic versus posterolateral thoracotomy. Eur J Cardiothorac Surg 37:827–832CrossRefPubMedGoogle Scholar
  2. Casali G, Walker W (2009) Video-assisted thoracic surgery lobectomy: can we afford it ? Eur J Cardiothorac Surg 35:423–428CrossRefPubMedGoogle Scholar
  3. Cho S, Do Y, Lee E (2010) Comparison of costs for video-assisted thoracic surgery lobectomy and open lobectomy for non-small cell lung cancer. Surg Endosc 25:1054–1061CrossRefPubMedGoogle Scholar
  4. Deen SA, Wilson JL, Wilshire CL, Vallieres E, Farivar AS, Aye RW et al (2014) Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches. Ann Thorac Surg 97:1000–1007CrossRefPubMedGoogle Scholar
  5. Ramos R, Masuet C, Gossot D (2012) Lobectomy for early-stage lung carcinoma: a cost analysis of full thoracoscopy versus posterolateral thoracotomy. Surg Endosc 26:431–437CrossRefPubMedGoogle Scholar

Management of Intraoperative Complications

  1. Boffa D, Gangadharan S, Kent M, Kerendi F, Onaitis M, Verrier E et al (2012) Self-perceived video-assisted thoracic surgery lobectomy proficiency by recent graduates of North American thoracic residencies. Interact Cardiovasc Thorac Surg 14:797–800CrossRefPubMedPubMedCentralGoogle Scholar
  2. Decaluwé H, Petersen RH, Hansen H, Piwkowski C, Augustin F, Brunelli A, Schmid T, Papagiannopoulos K, Moons J, Gossot D (2015a) Major intraoperative complications during video-assisted thoracoscopic anatomical lung resections: an intention-to-treat analysis. Eur J Cardiothorac Surg 48:588–598CrossRefPubMedGoogle Scholar
  3. Duan L, Chen X, Jiang G (2012) Lobar torsion after video-assisted thoracoscopic lobectomy: 2 case reports. Thorac Cardiovasc Surg 60:167–169CrossRefPubMedGoogle Scholar
  4. Flores RM, Ihekweazu U, Dycoco J, Rizk NP, Rusch VW, Bains MS et al (2011) Video-assisted thoracoscopic surgery (VATS) lobectomy: catastrophic intraoperative complications. J Thorac Cardiovasc Surg 142:1412–1417CrossRefPubMedGoogle Scholar
  5. Fournel L, Zaimi R, Grigoroiu M, Stern JB, Gossot D (2014) Totally thoracoscopic major pulmonary resections: an analysis of perioperative complications. Ann Thorac Surg 97:419–424CrossRefPubMedGoogle Scholar
  6. Liang C, Wen H, Guo Y, Shi B, Tian Y, Song Z et al (2013) Severe intraoperative complications during VATS lobectomy compared with thoracotomy lobectomy for early stage non-small cell lung cancer. J Thorac Dis 5:513–517PubMedPubMedCentralGoogle Scholar
  7. Mei J, Pu Q, Liao H, Lin M, Zhu Y, Liu L (2013) A novel method for troubleshooting vascular injury during anatomic thoracoscopic pulmonary resection without conversion to thoracotomy. Surg Endosc 27:530–537CrossRefPubMedGoogle Scholar
  8. Park J, Kim H, Choi Y, Kim J, Shim Y, Kim K (2011) Unplanned conversion to thoracotomy during video-assisted thoracic surgery lobectomy does not compromise the surgical outcome. World J Surg 35:590–595CrossRefPubMedGoogle Scholar
  9. Park H, Detterbeck F, Boffa D, Kim A (2012) Impact of hospital volume of thoracoscopic lobectomy on primary lung cancer outcomes. Ann Thorac Surg 93:372–379CrossRefPubMedGoogle Scholar
  10. Paul S, Sedrakyan A, Chiu Y, Nasar A, Port J, Lee P et al (2013) Outcomes after lobectomy using thoracoscopy vs thoracotomy: a comparative effectiveness analysis utilizing the nationwide inpatient sample database. Eur J Cardiothorac Surg 43:813–817CrossRefPubMedGoogle Scholar
  11. Petersen RH, Hansen HJ (2010) Learning thoracoscopic lobectomy. Eur J Cardiothorac Surg 37:516–520CrossRefPubMedGoogle Scholar
  12. Sung H, Kim H, Choi Y (2012) Re-thoracoscopic surgery for middle lobe torsion after right upper lobectomy. Eur J Cardiothorac Surg 42:582–583CrossRefPubMedGoogle Scholar
  13. Traibi A, Grigoroiu M, Boulitrop C, Urena A, Masuet-Aumatell C, Brian E, Gossot D (2013) Predictive factors for complications of anatomical pulmonary segmentectomies. Interact Cardiovasc Thorac Surg 17:838–844CrossRefPubMedPubMedCentralGoogle Scholar
  14. Yamashita S, Tokuishi K, Moroga T, Abe S, Yamamoto K, Miyahara S et al (2013) Totally thoracoscopic surgery and troubleshooting for bleeding in non-small cell lung cancer. Ann Thorac Surg 95:994–999CrossRefPubMedGoogle Scholar

Management of Fused Fissures

  1. Balsara KR, Balderson SS, D’Amico TA (2010) Surgical techniques to avoid parenchymal injury during lung resection (fissureless lobectomy). Thorac Surg Clin 20:365–369CrossRefPubMedGoogle Scholar
  2. Craig S, Walker W (1997) A proposed anatomical classification of the pulmonary fissures. J R Coll Surg Edinb 42:233–234PubMedGoogle Scholar
  3. Decaluwé H, Sokolow Y, Deryck F, Stanzi A, Depypere L, Moons J et al (2015b) Thoracoscopic tunnel technique for anatomical lung resections: a ‘fissure first, hilum last’ approach with staplers in the fissureless patient. Interact Cardiovasc Thorac Surg 21:2–7CrossRefPubMedGoogle Scholar
  4. Ng T, Ryder BA, Machan JT, Cioffi WG (2010) Decreasing the incidence of prolonged air leak after right upper lobectomy with the anterior fissureless technique. J Thorac Cardiovasc Surg 139:1007–1011CrossRefPubMedGoogle Scholar
  5. Nomori H, Ohtsuka T, Horio H, Naruke T, Suemasu K (2003) Thoracoscopic lobectomy for lung cancer with a largely fused fissure. Chest 123:619–622CrossRefPubMedGoogle Scholar

Management of the Intersegmental Plane

  1. Kuroda H, Dejima H, Mizumo T, Sakakura N, Sakao Y (2016) A new LigaSure technique for the formation of segmental plane by intravenous indocyanine green fluorescence during thoracoscopic anatomical segmentectomy. J Thorac Dis 8:1210–1216CrossRefPubMedPubMedCentralGoogle Scholar
  2. Sato M, Yamada T, Menju T, Aoyama A, Sato T, Chen F et al (2015) Virtual-assisted lung mapping: outcome of 100 consecutive cases in a single institute. Eur J Cardiothorac Surg 47:e131–e139CrossRefPubMedGoogle Scholar
  3. Sekine Y, Ko E, Oishi H, Miwa M (2012) A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green. J Thorac Cardiovasc Surg 143:1330–1335CrossRefPubMedGoogle Scholar
  4. Zhang Z, Liao Y, Ai B, Liu C (2015) Methylene blue staining: a new technique for identifying intersegmental planes in anatomic segmentectomy. Ann Thorac Surg 99:238–242CrossRefPubMedGoogle Scholar

3D Reconstruction

  1. Akiba T (2013) Utility of three-dimensional computed tomography in general thoracic surgery. Gen Thorac Cardiovasc Surg 12:676–684CrossRefGoogle Scholar
  2. Hagiwara M, Shimada Y, Kato Y, Nawa K, Makino Y, Furumoto H et al (2014) High-quality 3-dimensional image simulation for pulmonary lobectomy and segmentectomy: results of preoperative assessment of pulmonary vessels and short-term surgical outcomes in consecutive patients undergoing video-assisted thoracic surgery. Eur J Cardiothorac Surg 46:e120–e126CrossRefPubMedGoogle Scholar
  3. Iwano S, Yokoi K, Taniguchi T, Kawaguchi K, Fukui T, Naganawa S (2013) Planning of segmentectomy using three-dimensional computed tomography angiography with a virtual safety margin: technique and initial experience. Lung Cancer 81:410–415CrossRefPubMedGoogle Scholar
  4. Kanzak I, Kikkawa T, Shimizu T, Maeda H, Wachi N, Isaka T et al (2013) Presurgical planning using a three-dimensional pulmonary model of the actual anatomy of patient with primary lung cancer. Thorac Cardiovasc Surg 61:144–150CrossRefGoogle Scholar
  5. Yang Q, Xie B, Hu M, Sun X, Huang X, Guo M (2016) Thoracoscopic anatomic pulmonary segmentectomy: a 3-dimensional guided imaging system for lung operations. Interact Cardiovasc Thorac Surg 23:183–189CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Dominique Gossot
    • 1
  1. 1.IMM, Curie-Montsouris Thorax InstituteParisFrance

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